Provider Demographics
NPI:1740396092
Name:BAKSH, HUSNA (MD)
Entity Type:Individual
Prefix:DR
First Name:HUSNA
Middle Name:
Last Name:BAKSH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10750 COLUMBIA PIKE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-4402
Mailing Address - Country:US
Mailing Address - Phone:301-593-6072
Mailing Address - Fax:866-382-1197
Practice Address - Street 1:10750 COLUMBIA PIKE
Practice Address - Street 2:SUITE 401
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-4402
Practice Address - Country:US
Practice Address - Phone:301-593-6072
Practice Address - Fax:866-382-1197
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0043436207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD198561200Medicaid
DC484374Medicare ID - Type Unspecified
MD198561200Medicaid